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Antibiotics use for acute sinusitis in children reduces treatment failures: Insights from meta-analysis
USA: Acute sinusitis is a common childhood ailment characterized by inflammation of the paranasal sinuses, often triggered by viral upper respiratory tract infections. While antibiotics have traditionally been prescribed for acute sinusitis, there has been growing debate regarding their efficacy and necessity, particularly in the context of rising concerns about antibiotic resistance. A recent meta-analysis sheds light on this contentious issue, offering valuable insights into the role of antibiotics in acute sinusitis management in children.
In the study published in the Pediatrics Journal, antibiotics significantly reduced treatment failure rate compared with placebo in children with clinically diagnosed acute sinusitis. However, given the favorable natural history of sinusitis, the results could also support close observation without immediate antibiotic treatment.
The meta-analysis provides valuable insights into the use of antibiotics for acute sinusitis in children, highlighting the importance of evidence-based decision-making and antibiotic stewardship in pediatric practice
In children, acute sinusitis is one of the leading causes of antibiotic prescriptions. No recent systematic reviews have examined antibiotic efficacy compared with placebo.
The meta-analysis, conducted by Shannon J. Conway, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, and colleagues sought to determine if antibiotics are superior to placebo in the treatment of acute sinusitis in children.
For this purpose, Embase and Medline were searched from their origin to July 2023. Randomized placebo-controlled studies focusing on the treatment of acute sinusitis were considered. In all studies, symptoms were present for <4 weeks, and subjects were <18 years of age. Data extraction was done independently by two authors. Data was pooled primarily using fixed-effects models.
The researchers reported the following findings:
- Analysis of 6 included studies showed that antibiotic treatment reduced treatment failure rate by 41% (with a risk ratio of 0.59) compared with placebo.
- There was substantial heterogeneity between the studies (I2 = 69.7%), which decreased substantially when the 1 study with a high risk of bias was removed (I2 = 26.9%).
- Children treated with antibiotics were 1.6 times more likely to have diarrhea than those who were not treated with antibiotics (risk ratio = 1.62).
In conclusion, antibiotics effectively reduce the symptoms of children with clinically diagnosed acute sinusitis. However, given the favorable natural history of the condition, the results could also be viewed as supporting close observation without immediate antibiotic treatment.
"Our results underscore the importance of shared decision-making with parents of children with acute sinusitis," the researchers wrote.
The main limitation was that few studies were eligible for inclusion. The included studies differed in their methodology.
Reference:
Shannon J. Conway, Grace D. Mueller, Nader Shaikh; Antibiotics for Acute Sinusitis in Children: A Meta-Analysis. Pediatrics 2024; e2023064244. 10.1542/peds.2023-064244
MSc. Biotechnology
Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. She can be contacted at  editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751